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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DONOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 NO'e0359213 <br /> Date Work Began 12/17/2017 Ended12/13/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0037627 Permit Date 11/21/2017 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft, to Ft. Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 2 Top Soil Address 8484 Alpine Rd WELL LOCATIO <br /> 2 22 Clay City Stockton CA <br /> 22 33 Sand County San Joaquin <br /> 33 143 Clay APN Book Page Parcel <br /> 143 148 Sand Township Range Section <br /> 148 273 Clay Latitude I 1 1 <br /> 273 276 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 276 278 Clay LOCATION SKETCH ACTIVITY �) <br /> NORTH Z NEW WELL <br /> 278 284 Sand <br /> 284 303 Clay MODIFICATION/REPAIR <br /> N/RRrEPAIR <br /> pe <br /> 303 340 Sand —Other(Specify) <br /> — DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> WATER SUPPLY <br /> J) Domestic— Public <br /> uj Irrigation _ Industrial <br /> ul MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> SOUTH REMEDIATION_.. <br /> lllustrale or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 114 (FL)&DATE MEASURED 12/13/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 340 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 322 (Feet) Mav not be representative of a well's loo -term yield <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE BORE- .TYPE DEPTH <br /> HOLE — FROM SURFACE TYPE <br /> DIA. x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g W U J GRADE DIAMETER OR WALL IF ANY MENT TONI7 FILL FILTER PACK <br /> m Ir LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 302 12 <br /> 302 322 L <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — Well Constntction Diagram NAME_MASELLIS DRILLING INC <br /> Geophysical Logi(s) (PERSON,FIR?%R CORPORATI ) (TYPED OR PRINTED) <br /> — SoiWVater Chemical Analysis 119 IbeT Rd 357 <br /> — Other ADDRESS t CITY STATE ZIP <br /> `6` 12/13/17 668622 <br /> Signed � a' .. �'�� ��,� <br /> ATTACH ADDITIONAL INFORMATION,IF ITIXIS7S WELL DRILLER/AUTHO IZE� EPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />